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House Democrats Eye New Face for Medicare-for-All

A bill to create a single-payer health system is more popular than ever, which is
why it’s going to be a challenge to find it a new lead sponsor in the House, lawmakers
and supporters told Bloomberg Law.

House Democrats’ Medicare-for-all bill, now at the height of its popularity, has been
left without its author, Rep. John Conyers (D-Mich.), who left Congress amid sexual
harassment allegations earlier this month. In his absence, supporters of a universal,
public health insurance system are trying to determine who is best suited to carry
the bill forward and what shape the proposal will take in coming years.

House Democrats for more than a decade honored Conyers’ seniority as the longest-serving
member of Congress and an early advocate for single-payer. The goal for now, Democratic
supporters said, is to stay united around his bill and avoid any ideological divides
among themselves.

“Whoever’s name is first on the bill is important, but it’s also important we keep
the cohesiveness of the caucus,” Rep. Pramila Jayapal (D-Wash.), who won her seat
in Congress in 2016 on a single-payer platform, told Bloomberg Law.

More than 60 percent of House Democrats signed on as co-sponsors of Conyers’ Medicare-for-all
bill (
H.R. 676) this year, the most of any Congress.

Several House Democrats and aides said a successor has not been named. Usually, when
lawmakers leave Congress, they will name a successor for their signature legislation,
Democratic aides told Bloomberg Law. However, Conyers’s abrupt exit means that hasn’t
happened.

Longtime supporters of a single-payer health system told Bloomberg Law they also want
a say in who takes over the bill. Carol Paris, president of Physicians for a National
Health Program, said she wants someone who could win over moderate Democrats and Republicans.

House Minority Leader Nancy Pelosi (D-Calif.) is unlikely to get a say because she
has never signed onto single-payer legislation, nor have 73 other Democrats in the
House.

Opponents of the legislation say it’s too much of a departure from the current health
system. Republicans have criticized it as deficit-busting and Sen. Lindsey Graham
(R-S.C.) repeatedly pointed to it as the alternative to repealing the Affordable Care
Act.

Progressive groups, however, plan to make health care and support for a single-payer
system major issues during the 2018 midterm elections, Ken Zinn, political director
for National Nurses United, a national union of registered nurses, told Bloomberg
Law. Zinn said his group will push Democrats to support single payer in 2018.

Questions About Details

Supporters of the Conyers bill have long called it aspirational, a platform for Democrats
to show they have big ideas about reforming the nation’s health-care system. The bill
leaves out crucial details about how the nation would transition from its current
mix of public and private payers to one where the government foots the bill for nearly
every health service.

It also doesn’t specify how to pay for this new single-payer system, estimated at
over $30 trillion, other than using existing government revenues, increasing taxes
on the income of the wealthiest 5 percent of Americans, and other taxes.

As they discuss filling in those details, Democrats risk dividing themselves over
a bill they know won’t become law in the current Congress, where Republicans hold
majorities in both chambers, or under a Republican president.

Private insurers could not offer similar care and could only sell plans that cover
services not considered medically necessary, such as cosmetic surgery.

Khanna, a supporter of single payer, told Bloomberg Law he thinks this may be a bridge
too far. He thinks private insurance could continue within a Medicare-for-all system,
where public insurance is offered to anyone who can’t afford it.

“We all have different sense of the actual mechanics of how to get Medicare-for-all,”
Khanna said.

Other co-sponsors of Conyers’s bill have also noted the bill needs changes, but said
the bill stands as a placeholder for the issue of single payer.

Finding Answers

Two potential torchbearers for a House Medicare-for-all bill, Dingell and Jayapal,
told Bloomberg Law they plan to work together next year to iron out many of these
details and draw more support among Democrats for it.

Jayapal said they need to determine how to transition the country into a single-payer
system without throwing people off their insurance or altering how they get care.

Dingell said she wants a serious, specific proposal ready to go if Democrats take
control of Congress and the White House again. She’s hoping to get it ready sooner
rather than later, too.

“I’m going to travel the country to sell this bill,” Dingell said. “I’m going to look
at how we finance this, how other countries finance this, and how to get every American
access to health care.”

Whether in 2019 House Democrats reintroduce Conyers’s bill, which has been H.R. 676
since 2003, so it retains that number for supporters, or replace it with Sen. Bernie
Sanders’s (I-Vt.) bill,
(S. 1804), in Conyers’s absence is unclear.

Sanders’s bill contains details about phasing in single payer than Conyers’s bill
doesn’t, Jayapal said. For example, the Sanders bill would convert Medicare into a
more generous program, eliminating deductibles and other payments, then gradually
expand it over four years.

Some Democrats contend the details of a single-payer bill won’t matter unless they
can win more elections and take control of Congress.

Ellison said working out who takes over Conyers’s bill isn’t as important as showing
Democrats can be united on the issue.

“My main concern is: Can we achieve the majorities in which we can pass it,” he said.
“I"m going to focus on getting in a position to pass something.”

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